New to BFing and struggling

[shanaz]

Hi

So, my DD2 was born 6 wks prem and is now 3 wks 5 days old.  we were in SCBU in hospital for 16 days during which time I worked very hard to establish BFing which was hindered by the fact that I have flat nipples.  I've been using nipple shields successfully since my milk came in.  I was unable to BF my DD1 due to neck issues that were undetected until she was 6 wks old and I was really keen to BF this time for a number of reasons - financial as formula is so expensive, convenience as bottles are such a pain when trying to go anywhere or do anything! 

Anyway, we've been home for around 1.5 weeks.  I am struggling on a number of levels including finding a good position to feed her but the main issues are as follows:

I'm struggling a bit and it's probably mostly in my head and exaccerbated by lack of sleep but this is what is happening:

1.  During the day she has generally been feeding well, doing around 30-40 mins worth of feeding and had been falling asleep and resting well between feeds for a couple of hours.  This has changed today, not very much rest and some feeds have been short (max 15 mins) or have been a total of 40 mins of feeding time but spread out over 1.5-2 hrs.  Very little rest in between and even when she is asleep she is very wriggly and crying out.

2.  Last night she started really doing the short feeds again, often only doing 5-6 mins before zonking out.  As soon as I tried to put her down (either next to me or in her carrycot) she would wake and start rooting around again.  She would only really sleep in snatches and as long as she was being held by DH or I.  I actually ended up falling asleep propped up with her on my chest at one point as she just wouldn't settle at all.  As soon as I lay her down next to me she started rooting around.  I guess she probably went anywhere between 1.5 hrs and 2.5 hrs between feeds but her feeds were spread out over 1 - 2 hr periods.  I have been keeping a note on my iphone note thing and copy a section as an example:

Saturday eve
20:18-20:35 (L) 17 mins
20:46-21:03 (L)  17 mins
21:11-21:16on and off  (R)
21:26-21:36 (R) 10 mins

22:30-22:42 (R) 12 mins

23:25-23:32 (L) 7 mins
23:59-00:06 (L) 7 mins

Sun 03.06.12
Wet
00:19-00:26 (L) 7 mins

02:18-02:28 (R)  10 mins max,

04:25-04:40 (R) but v on and off
04:42-04:49 (L), same, on and off
04:57-5:08 (L) 11 mins
05:20-05:25 (L)

Wet
 08:00-08:20 (L) 20 mins
08:31-08:42 (R) - not sure she's getting anything from it?  No milk in shield.
08:44-???

3.  So, what are my main concerns? 
   i)  She is not resting, for example, she has been awake on & off between 3.45pm - 8.45pm.  Being prem and still so young, she should really be getting lots of rest shouldn't she?
   ii) By using the nipple shield am I stopping her being able to get enough milk?  I wonder whether she is getting worn out feeding through it and so keeps falling asleep on the boob only to wake and still be hungry.  I am trying to not use the shields but cannot always get her latched on without it. .
   iii)  Excessive wind - this has def become a problem again.   She is constantly possetting, sometimes what looks like new milk, other times quite curdled/digested milk.  This seems to be exacerbated by being put down or moved.  She cries out, drawing up her legs, arching her back and straining.  She is doing wet nappies throughout the day and around 2 dirty nappies in a 24 hr period.

4.  I feel so very lacking in confidence in my ability to feed her and keep her satiated.  I worry that she is always hungry and unable to rest because she is not getting enough.  I am aware that this is probably all in my head and that I am stressing myself out needlessly but I think lack of sleep is not allowing me to be very rational.  I feel like the only contact I have with her is to feed her as she won't rest on me, almost always rooting around when on me.  I am getting stupidly tearful and very negative about everything which isn't a good place to be. 

Just to clarify, she had gained a further 60g when weighed yesterday so I know that she is doing ok in that regard.  I guess I need to know whether this is quite normal feeding behaviour for a prem baby  and whether she will settle down as time goes on.   We haven't started doing the BW stuff yet as technically she should still be inside for a few more weeks and I wanted to just focus on feeding and sleep, neither of which seem to be going very well at the moment!

Ok, I've rambled on for too long, all advice gratefully received.

Shanaz

[shanaz]

Oh, I should have said, my breasts are almost always pretty soft and I think this makes me worry about whether I have enough milk but if I do a quick test pump then there is always milk there so I guess I shouldn't really worry.  My main concern is when I sometimes end up going 8 hrs between feeds on a boob.  Surely this will deplete my supply soon? 

I also meant to say that she was 8lbs 10oz at birth (34wks+1) and now weighs 6lbs 3oz.

TIA

[Fiver]

Hi Shanaz, just on my way to bed, but couldn't read and run.  I have no experience at all with what to expect from prems, but some of what you're describing does sound like general NB behaviour.

Certainly some LOs, whether prem or not, struggle to feed to the optimum with nipple shields.  When I used them, briefly, my BFC suggested turning them by 90 degrees from how the packet instructions say in order to give as much skin to skin contact at the breast as possible when sucking.  Have you got a local BF support group with a breastfeeding counsellor/lactation consultant/MW skilled and trained adequately in BF who could support you with this as well?

The fact that she's gaining weight is a good sign.

[Claudiamummy]

Hey, not much advise from me, BUT I just wanted to offer hugs...

Dd also went through a very rough stage around 6weeks.... But it did pass I just went one day at a time

Does your DD have reflux? Just wondering about the possetting/squirming and crying out???

Finally a huge well done!! You have done amazing overcoming hurdles to get THIS far!

Hope you get more specific advise soon
Xxxx

[Erin M]

There's a growth spurt around the 2-3 week mark and another around 6 weeks.  The recent feeding sounds a lot like gs behavior.  It sounds like you're doing ok, but like Amanda said I might find some IRL support to help with the nipple shields -- though FWIW I have an IRL friend who fed for 3 months with them and went on to nurse for 2+ years. 

[eva026]

I've been using shields on and off for 3months. On for the last 1.5month in fact.
We were told to use them because DD had trouble nursing and they apparently make it easier to get milk out as sucking creates a vacuum in the chamber.
I have noticed that the kind of shield you use makes a huge difference.  At the start I had avent ones but the shape was very unnatural and they only had 2 flaps around the chamber which meant they kept slipping off. Now I use medela ones that only have a part cut out that I place where her bottom lip and chin go and they work much better.
Someone posted an article about new research on nipple shields and how the modern ones don't in fact hinder milk transfer. I think it's in one of the posts about nipple shields.

The constant feeding and crying when put down sounds like what my LO did during a GS. We went 3 h of feeding and then 3h of sleeping for a week at a time!